15D2180939 CLIA NUMBER - APPLEGATE HEALTH SERVICES, INC APPLEGATE RECOVERY KOKOMO

Laboratory Demographics

  • CLIA Code: 15D2180939
  • Facility Name: APPLEGATE HEALTH SERVICES, INC APPLEGATE RECOVERY KOKOMO
  • Facility Address: 1542 SOUTH DIXON ROAD, SUITE C
    KOKOMO, IN
    ZIP 46902
  • Facility Phone: 765 570-5014
  • Facility Type: Other - NARCOTIC TREATMENT PROGRA
  • Facility Type: Waiver
  • Lab Director: RICHARD MAENZA
  • NPI Number: 1356017487
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2180939
LAB Type Other - NARCOTIC TREATMENT PROGRA
Facility Name APPLEGATE HEALTH SERVICES, INC APPLEGATE RECOVERY KOKOMO
Street 1542 SOUTH DIXON ROAD, SUITE C
City KOKOMO
State IN
ZIP 46902
Phone 765 570-5014
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2024
Certificate Expiration Date 3/23/2026
Facility Type Other - NARCOTIC TREATMENT PROGRA
Lab Director RICHARD MAENZA

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This page was last updated on: 9/29/2025